On measures of association for multiple-cause mortality: Do we need more measures?

Sulaiman Bah, M. Mahibbur Rahman

Abstract

More than 70 measures exist for analyzing the binary association of a 2x2 contingency table. Of these, only five are used in multiple-cause mortality. The aim of the paper is to answer the question of whether these measures are adequate. Building on comparative reviews of measures of association, the paper identifies three additional measures as suitable candidates. These additional measures, together with the five existing ones, are assessed for their theoretical utility based on seven criteria laid out in the paper. Subsequently, the same measures are applied to South African multiple-cause data that comprises over four million records. The multiple-causesoftware Cause_limp v1.1 was used to extract the data for the cell entries of the 2x2 contingency table, with diabetes as a multiple-cause and cardiac arrest as a co-morbid condition. The paperconcludes that existing measures of multiple-cause mortality need to be supplemented with other measures, in particular the Positive Matching Index (PMI). This measure is found to satisfy allthe criteria laid out, and produces the most consistent results among all the measures compared.